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HomeMy WebLinkAbout020-1292-20-000 4 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER S/~ ✓j ~'I/~~ ADDRESS l3oy Z 8 Z FED W `t` SUBDIVISION / CSM# au, vtn , v N , LOT # SECTION Z T -2'/ N-R Town of ~I K cI _c ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYST M • B. N~, I 12d 1~ UU ~sT ~ ~ DoT L'•~~ ~o~nQ~ of lets o y✓ - 1, 1 D.31' s 59 E ~~,k Sv , a,,,~s2 h :*oT6 45 <)r f/A s KaT AET 32 4 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. I i r / BENCHMARK: t ~j 2c~Xl Ovt W a.. S~ Lof - ' /7, 30 ALTERNATE BM: To ,o c~ Ri>C-L S m.~ e-90 .A,,,. ;C* CtA = 0.00 QiEETAND / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: LQ I,'S"t/ Liquid Capacity: (po 0 Setback from: Well -1- House/ q_ Other 1yy6t1-T: Pump: Manufacturer - Model# Size - Float seperation - Gallons/cycle: Alarm Location SOIL ABSORPTION SYSTEM Width:-'8 ~ Length_ Number of trenches _Distance-&-Direction-to_nea-rest-prop.--line-_ :I.n-~Q Setback from: well: ~b 7 House -S Other ELEVATIONS 00 J Building Sewer ST Inlet: 5.0~ ST outlet S" ~S PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing Grade Final grade 7, DATE OF INSTALLATION: PLUMBER ON JOB:, ~4 a -t LICENSE NUMBER: 2 INSPECTOR: 3/93:jt ■ Wisconsin Department of Industry, County: Labor and Human Relations PRIVATE SEWAGE SYSTEM ST. CROIX Safety and Buildings Division INSPECTION REPORT (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 21 RR65 E] City E] Village IR Town of: State Plan ID No-: Perp;,it l-f~o~~tCC's N I Hudson CST BBMLLElev.:: ~HC1Insp BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmarks Dos' //7-33 33 Aeration Bldg. Sewer Ing SthW Inlet TANK SETBACK INFORMATION St 1,W Outlet TANKTO P/L WELL BLDG. Airi to ntake ROAD Dt Inlet Ar I Septic NA Dt Bottom Dosi NA Header f A&an pm w6, cl~ Aeration N Dist. Pipe Holding Bot. System ' PUMP/ SIPHON INFORMATION Final Grade? Manufacturer Demand Model Number GPM TDH Lift Fri TnW Forcemain Length Dia. Dist. To wen SOIL ABSORPTION SYSTEM BED/TRENCH Width p r Length , No. Of Trgnches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /a d / DIMENSIONS SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type O Ae,_ 11-1 i A Model Number: System: I -~v'~, 5`~ 3 f7 OR UNIT DISTRIBUTION SYSTEM Header / , Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length /A 1 Dia- Length 37 Dia. Spacing i SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Sys y Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /-ieenrhCenter off - 1J Bed /~h Edges Topsoil ❑ Yes ❑ No ❑ Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: Hudson-27.29.19W, NE, NE, Lot 13, Badlands Road, "7,Q_-i_,,~ C2t,-.~ll"C~~` Plan revision required? ❑ Yes 2_X_0 Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signat re Cert. No. SANITARY PERMIT APPLICATION ri'~L■7■7 In accord with ILHR 83.05, Wis. Adm. Code Co TY . C2a ryC STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than a' %Th'✓5 8% X 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION SA )ILFt #E 1/4A F, '/4,SZ7 T3.0/,N,R 79 E(or)~ PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # 13,OX 0 2 V -X lj CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 0P30wL SYdI4 1(34y, 2241 MJMSheD N114 s II. TYPE OF BUILDING: (Check one CITY NEAREST ROAD ) ❑ State Owned D VILLAGE NV~S bA/ ISAPLAWDS RDA D ❑ Public K 1 or 2 Fam. Dwelling-# of bedrooms 3 PAR ELTAX NUMBER( ) III. BUILDING USE: (If building type is public, check all that apply) O Z 0 Z 9 Z .4 2 0 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 120 Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 13E] Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.0 Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank i 12 Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVAT)ON 4/ s- O to q o /011140 Feet / Q t 6v Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New lExisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank X+_ 000 1 h s E 0- F] I F1 1 11 Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: 4'S' f1~T Z 2 yI 2.3 Z Plumber's Address (Street, City, State, Zip Code): ,,e if k-*-/ 2 2.- NC-W A24 # AA0h' P W.Z, S~Q® IX. C NTY/DEPARTMENT USE ONLY ❑ Disapproved Sagi1ary Permit Fee (Includes Groundwater [Date Issued Issuing Ag t Sig lure (No S mps) +y¢Sy Approved El Owner Given initial co" / Surcharge Feel Adverse Determination UU C(J~ X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398(8.08/93) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 603-266-3815. To be complete and accurate this sanitary s sa y permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber mus4 sign application form. IX. County/Department Use Only. X. County/Department Use Only. I Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. - - - - - - - - GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) SAM MILLF•R HOMBIQ.D HILL 3 L07 13 05- y3f~°1, E/. 41? s~al~ I/Y io O S M To#) of ?/Pe ov zer !/NE CDR NFF of LoT f /Z El. . . '-"f ~7 (.7 7 B a~ !a 9 s 2 v ~4 EAsr L07 L /NE 383.70'/~C I c~ eA,c E p ~ Svc ~/p r • / $S~ weLL S ys'Fa~+~ 1.144E14 yo oo . ,.A"- 10y,bo~ , I ; yg•~ 14 o~3 F_ .0 28ir~D~ 0 !S ' (0 AL7FRNA7E I 3 S AREA h ~ ~ F L , l0 3, So r d pppVVVnnn ~ + ` 31 v ~ h ~ K o LoT 13 9,M. To? of I" Rolf TIPE ON LoT,/ l./#9 to2NE9 of LOT5 N/r sT LoT/NE 383.70 ~yY SI,rIE~ itl 2 E _ /DU, 00' _ /66. S 7' i LOT LoT Iz Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 Lrbo. and Human Relations .0 ndsiM3f Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code 000NTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST 40 1k f not limited to vertical and horizontal reference point (BM), direction and % of slope, scale of PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY O~1W~,NER: PROPERTY LOCATION 54M I' ( ! ELLS GOVT. LOT E 1/4 NIA 1/4,SZ f T Z 9 N,R ~q E (or) W PROPERTY O NER':S MAILIN~J~PDDRESS LOY BLOCK # SUBD. AME OR CSM # CITI~ STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE Z~rOWN N 64R ST ROAD New Construction Use [4 Residential / Number of bedrooms '3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate ©S bed, gpd/ft2 0.6 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maxirr~m design loading rate 0•1 bed, gpd/ft2 ~•g trench, gpolft2 Recommended infiltration surface elevation(s) 43^j PA4C 3 aF ft (as referred to site plan benchmark) Additional design / site considerations Parent material Flood plain elevation, if applicable It S = Suitable for system 0 VENTIONAL M~Oy ND IN ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem S 1:1 U &S, ❑ U V'S ❑ U IBS ❑ U jfS ❑ L ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence ftyclay Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench E A -1 3 Z c K 9, /1-2/ /6,/4 4- 3 - SC 1 r ni C 0.4 .4 Ground $ I O 4 S QM ,2r M l 0.7 0% elev. /1/.S) ft. Depth to i5 tZ~AN t w THrN THC Nio I"Zolimiting 7 I t o' 47' y~ Remarks: Boring # ah C 7- 16-5:0.6 bK Z g~ 17- 37 /D 44? 5 r I! sb n~~r 1 10.4 O.S 97 137-34 /6/ 3 A Ground elev. /D7 ~9fL Depth to limiting factor >'7.00 Remarks: CST Name. Please Print t4 Ig ~ Phone: Address: U iDSa ] c.JO Signature: Date: - A Q 4 CST Number: ~~g PROPERTYOWNER 'S4* MikL" SOIL DESCRIPTION REPORT Page? of 3 /3 110 1*4 9A,& PARCEL Lf). # ' LeT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourg Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench El 8, 43 Ground _12 4 ¢ 5 r rh l 1 0~ •~S elev. fo7 99ft. Depth to limiting factor > Remarks: Boring # A 0-s' ioy~23 --r L 1 sbK M~'~ e O 4 D,S Ground $ /ey ~ 4 r N 1 ! 0.7 O S m! 7 o,g elev. 8 40/7 114 Ito 31 ft. Depth to limiting factor > S Remarks: Boring # S 1 e r ~~r- 1Z z- 0.4 0,~ • 02% / o`/A 3A rmw /ayr~ 0A 0,5' ; Ground 4 3~ 6 AA S d r rh~ C / 0elev. B 16`/P S 4 s r !6' 7 9`ft. Depth to limiting Remarks: Boring # A (9-~ IOZl1e 3 2 a bv, /hY C O.S €0 Sit- i q bk e 1 6A a~ . - S d M r M 1 10~7 a >e 4-14 Ground - /6 S S O n~ r 1! l 0-1 0 elev. Depth to limiting factor > /A Remarks: SBD-8330(R.05/92) r r P.44C 0 a I ~ r l~ Q M o ► r I U_ I j\ i r I Q ~ I Q rN 1 1 d1 ,4 M 41 1f ~.I o r4 o° ' 9. a i ,y ~qq ~ ► ~ 4 Ali V uJ I t~ I 13 i J tii 0 =d ti CL o W d 0. Z (L -i xY 1~-- O QQQQZ UZ = I- F- C9 y > x v o o Zd c~ O a) F- T O T 00 =d. z I ~ N o.. I M W I z I I w I t I a CL I I I I o I I Ilk I K) a I I I i i S z U z o U) CL LLI a c~ 0 w IL 110 m I w I < t a I °L W m ZZ > I p I I I a U I U4 =d Z ►l 1 I I ~ I I I I > ~ Z L1 r~ 'a' -fl to S 89'44'13"E 617-13- 14. 14' _ ~ it 1 1 208.40' 14.00 128.99' 0 339. 7' S89°26'4 617.16' 277.29• 14.24 D / I Z W w o O • rn O D ~ o w 1 1 O, to w `0 H m a, N N NdQ v, h ' D b cn ,A ' S o n 'n b m = n s. - FS m "I t4 'TI 0 ' 6 6, 0 6 (62)- CA z I 0 ~ ro ~ { o ~ 277.29 O 340 S 89026'42"W 617.34' 290. 04' ..fl 344.96' 1 1 1 S 89'57.17•W 625.00• 1 IT 1 1 w t~ ~N 0 of N H ✓ I 37 X1.92 N 77'23.21 E S 89'57'17"W -358.05& Q Z .r= r Ln 'D O O o` Ln O co I-a nC/) Ohm to N v O N w 1 T STC-105 SEPTIC TANK MAIN'T'ENANCE AGREEMENT St. Croix County OWNER/BUYER SA M M E AL- MAILING ADDRESS CJ X S A c v -r S D G PROPERTY ADDRESS ~v -7 ~A D L A N~ S k 0 041) v,p soh w;~ Syn (location of septic system) Please obtain from the Planning Dept. CITY/STATE 14 V PROPERTY LOCATION /NLC 1/49 11E 1/4, section 2 7 T Z 9 N-R _L7 W TOWN OF A U D n 4 A/ ST. CROIX COUNTY, WI SUBDIVISION 1 J IN k Q 1 G N i L L~ ; LOT NUMBER 1 3 CERTIFIED SURVEY MAP ~ 71 VOLUME 6- PAGE LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60%. of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. D SIGNED: DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property 5,4 M M IL 1-,F it_ Location of property ME 1/4 XE 1/4, Section Z 7 , TZ? N-R~ Township RL) 17 p P-.. Mailingaddress /?oj(0Z /Z--- 1- t\ , W-T-- S V v j G Address of site (p 7-7 Ba~\ L.a to D ~ o a P. Subdivision name !it 14(L L- ..i Lot no. /3 Other homes on property? Yes X' No Previous owner of property N u w.6; . j,Q,A&L co_ Total size of property 2. SS y i4 Total size of parcel 2. S S /4 C Date parcel was created 7- I L S 3 Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? .r Yes No Volume 02/ and Page Number Z 8 Z as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. Soi.Z oq , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. s'o2 zoq Signatur f Applicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 THIS SPACE RESERVED FOR RECORDING DATA WARRANTY DEED 5022.09 VOL REGiSTEF?"S OFFICE s1. C~o;x Co., W1 w This Deed, made between ..Humbird..Land Corporation, R:;C'd for Rccord . A Minnesota Corporation authorized to do.btsines._.. in-.Wisconsin JUL ~.2 1993 and iller Grantor, at 4:2 0 P. X19 Sam E M Register of Deeds Grantee, witneSSeth, That the said Grantor, for a valuable consideration...... 1 • conveys to Grantee the following described real estate in t CIOlX RETURN TO _ F County, State of Wisconsin. Lots 1, 2, 3, 4, 5, 5, 7, 8, 9, 10, 11 and 12 in the Plat of Humbird Hills, Town of Hudson as filed Tax Parcel No : -..and recorded in the office of the Register of Deeds for .=St. Croix County on April 7, 1993 in Vol. 5 of Plats, Page .:.99, Document No. 497107. Lots 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 and 25 "'in the Plat of Humbird Hills 1st Addition as filed and recorded , in the Office of the register of Deeds for St. Croix County on April 7, 1993, in Vol. 5, Page 100, Document No. 497,108. 'tea}~' v"'.li~C4-M~ ~~y~ ~ _y, a•+ 'v-. Y.:Y^ L +A: c'G RG t 7W t 2 :.yam+~,-'a x i This i g..Il homestead property. (,isJ (is not) Together wish all and singular the hereditaments and appurtenances thereunto belonging; And._.KLIWbi > Si..Ia ASL_~r^.r~o~r8i a~.__..._..-• warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except .easements shown on the above mentioned plats. and will warrant and defend the same. . Dated this 12th day of ...Ju1X.......................................................... Humbird Land Corporation,.a Minnesota Corporation authorized to do business in Wisconsin _ (SEAL) ...............(SEAL) By.... a Austin J. Baillon, President (SEAL) .....................(SEAL) i AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN . ss. ~_.Sl.. ~ ...!...County. authenticated this day of 19...... Personally came before me this *.1't.Aday of July 19.11. the abaV?Ym rued a -4'1u Bai114n,._ President If... 1.ic TITLE: MEMBER STATE BAR OF WISCONSIN H>,Rq>~krd_-t,~an• Corporatiog_ ~•;._--1-]•~-• (If not . ~ j_.... -~L_ : r. authorized by § 706.06, Wis. Stats.) to me known to be the person ? W4 ecuted the ; C - foregoing ' strument and acknowledg41l}e as d Q H•: O , THIS INSTRUMENT WAS DRAFTED BY Ll~ H N V ~,yQ'Q,a••,.••• _____...._..a~... 1..._ -Kueppersr.-Hackel._&_1CueppeLS......................... ~ • r .135.0--Capital..Centre, __St.._.Pau1,..BA_,55L02._ Notary lie ....5 T......~ .Q.L County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration are not necessary.) date: 19......... ) -Names of persons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co. Inc. FORM No- 1-1982 Milwaukee, Win. , .r. r".r t..G'• :s.:':C,i • F N. ii ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r x u N n x n. - M~..b ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 August 31, 1994 FAXED TO YOU THIS DATE First Federal of LaCrosse P.O. Box 263 Hudson, Wisconsin 54016 ATTN: Jae Olson RE: Septic Inspection for Sam Miller Lot 13, Humbird Hills Dear Ms. Olson: An inspection of the septic system for the Sam Miller property was conducted on July 19, 1994. This property is located in the NE; of the NE; of Section 27, T29N-R19W, Lot 13, Humbird Hills, Town of Hudson, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a three (3) bedroom home. If you have any questions with regard to the above, please do not hesitate in contacting our office. fS' rely, Jies K. Thompson Assistant Zoning Administrator St. Croix County, Wisconsin mz I I